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Results released today by AED at a conference held at the National Press Club reveal that in a decade-long initiative to protect millions of families from malaria in sub-Saharan Africa, a U.S. government-funded project helped sell 50 million bed nets in seven countries, crafted a voucher system to allow the poor to receive them for free or partial cost, and created enough incentives for private companies that they invested $88 million to expand their businesses.

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This new commercial approach also helped reduce the price of insecticide-treated mosquito nets by 30 to 70 percent. Now, those nets sell for between US$4 and US$7.

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The NetMark project, a $67 million, USAID-funded public-private partnership to prevent malaria, ends September 30, but the bed net market continues to thrive in seven countries where it operated—Nigeria, Senegal, Mali, Ghana, Uganda, Ethiopia, and Zambia. Not only did the U.S. investment help spur major spending by private companies—for every $1 in public funds, African and international businesses spent $1.30—the new commercial sector now exists.

"We worked ourselves out of a job. They don't need us anymore, and I'm proud of that," said Juan Manuel Urrutia, AED's Johannesburg-based deputy director of NetMark. "There are now 41 African distributors who will continue to sell thousands or millions of nets in those seven countries. The voucher system is now entrenched."

Malaria, a preventable and treatable disease, is one of the biggest killers of young children in Africa. Overall, the disease, which is transmitted by mosquitoes, kills an estimated 1 million people annually, the vast majority of them in Africa. One of the most effective preventive measures against malaria is to sleep under insecticide-treated bed nets, which are a finely woven barrier and kill most mosquitoes upon contact.

NetMark, which started in 1999, worked like this: It formed partnerships with international net and insecticide manufacturers and African distributors to create retail markets. Under NetMark, all parties worked together to launch the commercial marketing of insecticide-treated nets, or ITNs. The distributors put the nets into retail outlets. And the stores, most of which hadn't been selling bed nets, soon found a demand for them in part because of NetMark's national awareness campaigns on the benefits of using insecticide-treated nets.

Later, NetMark created a discount voucher system in which people who could not afford the nets brought the voucher to a retailer, who was later reimbursed by the program. It fulfilled two goals—making sure families in poverty would get the nets for free or low cost, and the storeowner's business was not undercut. The results were indisputable. Two examples: Awareness of insecticide-treated nets among Ugandan women grew from 23 percent in 2000 to 98 percent in 2006; and 2.1 million African families used a voucher for a net from a commercial outlet. Other groups, embracing the concept, started voucher systems of their own.

"Before NetMark began, families could not go to the market and buy a life-saving insecticide-treated net, and now they can," said AED President Stephen F. Moseley. "This program made treated nets easily accessible to everyone."

Admiral Timothy Ziemer, U.S. Malaria Coordinator, said the project helped build a "culture" of bed net use. "U.S. investments through NetMark contributed to dramatically expanding the availability and use of insecticide-treated mosquito nets in Africa," he said.

An estimated 70 to 80 percent of all bed nets in Africa are giveaways, according to studies. AED's experience shows, though, that a commercial market can thrive side-by-side with public handouts, becoming an important complement to the free distribution. Not only does the market offer choice of different types of nets to Africans who can afford them, but analysts believe it is vitally important to keep the market alive: It creates a new commercial sector and it provides a backup system for net distribution if donors' funding drops due to the current global financial crisis or to other emerging health threats.

"One thing we have learned again and again in public health is that if you have a couple of approaches and strategies, it's a lot better than to have only one," said Professor Christian Lengeler, head of the Heath Interventions Unit at the Swiss Tropical Institute, an independent academic foundation.

Lengeler and others believe that the AED-NetMark model in establishing a commercial distribution system for bed nets—supported by direct sales and with vouchers—can be replicated to fight other public health challenges.

Jeffrey L. Sturchio, President and CEO of the Global Health Council, praised the initiative for creating a model that will last. "This project shows the surprising results that come from combining creativity, commitment, and commercial innovation on global health issues," he said. "It also shows that novel partnerships, bringing the public and private sectors together, can achieve impressive improvements in public health in a way that is reliable and sustainable."

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